Enrollment Form

	SIGN YOUR OPERATORS UP TODAY TO SAVE ON EXTRA MELT^® CHEESE !

Must fill out form completely. Bold are required fields.


I am:	an Operatora BrokerLand O'Lakes Sales
Establishment Name:
Contact Name:
Title:
Street Address: No PO Boxes
City:
State:
Zip:
Phone Number:	- -
Email Address:
	I do not have an email address

	Independent
	Chain
	# Units:
	If more than one unit, enter complete listing. Please include establishment name, address, city, state & zip for each unit

Primary Distributor:
City:
State:
Distributor Sales Representative:
Secondary Distributor:
City:
State:
Brokerage House:
Broker Sales Representative:
BSR Email:

Preferred Language for Communication:
English	Spanish

My foodservice operation can best be described as one of the following:
Casual Dining	Family Dining
Other:

My menu can best be described as:
Mexican/Southwestern	American
Hamburger	Other:

Estimated average monthly usage of LAND O' LAKES® Extra Melt?* cases
* Operators must purchase a minimum of 25 cases per month to qualify for Performance Extra Savings



Questions? Call 1-800-361-4902